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Can maternal plasma C-reative protein replace amniocentesis for the detection of intra-amniotic infection in patients with preterm labor?
302
145
SPO Abstracts
CAN MATERNAL PLASMA C-REACTIVE PROTEIN REPLACE AMNIOCENTESIS FOR THE DE'I~CTION OF INTRA-AMNIOTIC INFECTION IN PATIENTS WITH PRETERM LABOR? H. Mufinzx, R. Romero, M. Galasso x, R. Gomez x, M. Mazor, F. Ghezzl x, L Coh~ x, M. Ossandon x, D.B. Cotton. Wayne State University/Hutzel Hospital, Detroit, MI, Perinatology Research Branch, NICHD, Betheada, MD. BACKGROUND/OB,IF~TIVE: Recently much emphasis has been placed on the use of araniotic fluid (AF) tests to detect intra-amniotic infection in patientswith preterm labor. However, AF analysisrequires the performance of an invasive procedure: amniocentesis. Several groups have proposed the use of maternal C-Reactive Protein (CRP) as a less invasive alternative to amniocentesis. This study was conducted to compare the diagnostic performance of maternal plasma C R P vs. A F analysis. S T U D Y DESIGN: Maternal plasma was obtained at the time of aranioccntesisin 134 consecutivepatientswith singletongestationsadmitted with the diagnosisof preterm labor and intactmembranes. Maternal plasma C R P was measured by ELISA. A F was cultured for aerobic and anaerobic bacteriaas well as Mycoplasma. T w o A F testswere performed: the Gram stain (GS) and interleukin-6(IL-6) determinations. A F IL-6 was measured by ELISA (sensitivity:1.0 ng/ml). Statisticalanalysiswas performed using R O C curve and logisticregression. R E S U L T S : I) PositiveA F cultures occurred in 13.4% of cases; 2) The sensitivityand specificityof A F analysiswas better than that of CRP; 3) Diagnostic indicesand positiveand negativepredictivevalues are displayed in the following table: Sans. Spec. PPV NFV RR 95% C.I. Anmiocnatesis 88.9% 83.6% 45.7% 98.0% 5.4 3.49-8.45 MPCRP;~20.7 /.~g/ml 64.7% 73.3% 26.2% 93.4% 4.0 1.6-10.0 Stepwise logistic analysis demonstrated that when maternal blood CRP was first entered into the model to predict AF culture results or the occurrence of preterm delivery, GS and AF IL-6 concentrations improved significantly the X2(A= 19.9). On the other hand, maternal plasma CRP did not add any significant information to that provided by AF analysis with GS and IL-6. CONCLUSION: Amniotic fluid analysis is superior to maternal plasma CRP in both the detection of infection and the prediction of tocolysis failure (i.e., preterm delivery).
146 PREDICTORS OF GENITAL COLONIZATION W I T H GROUP B
STREPTOCOCCUS(GBS) IN LABORING WOMEN E.R: Newton, J. Piper, W Peairs. Dept. of Ob/Gyn, University of Texas Health ScienceCenter at San Antonio. OBJECTIVE: We sought to determine demographic and clinical predictors of genital colonization with Group R Streptococcus (GBS)among laboring women. METHODS: Between October 1993 and April 1994, B16 laboring women had a rectovaginal culture for GBS. GBS was transported, isolated, and identified using standard microbiologic techniques. Clinical information was abstracted using standard definitions and forms during the postpartum hospitalization. Predictors were identified using stepwise logistic regression. RESULTS: 95 (11.7%) had positive genital cultures for GBS. A positive history for human papillomavirus (HPV) infection (warts or abnormal Pap smear) was associated with positive rectovaginal GBS cultures (adjusted odds ratio, 2.2 [1.09-4.45 95th CI]) and heavy colonization (3-4+), 2.7 (1.31-5.53). Preterm gestation was associated with heavy colonization, 1.9 (1.04-3.43). Race, economic status, age <20, nulliparity, other STD, meconium, smoking, nor drug abuse were associated with GBS colonization. CONCLUSION: A history of clinical HPV infection is an additional criterion to identify laboring women at risk for rectovaginal colonization with GBS. The greater risk of GBS neonatal sepsis in preterm deliveries than in term deliveries may be related in part to the greater likelihood for heavy colonization in preterm gestation. Except for preterm labor, most other common demographic and clinical markers will not identify a population to selectively screen and treat for GBScolonization.
J a n u a r y 1995 A m J Obstet Gynecol
147 DOES THE PRESENCE OF BACTERIAL VAGINOSIS INTRAPARTUM
INCREASE THE LIKELIHOODOF INTRA-AMNIOTIC INFECTION? E.R:
Newton, J. Piper, W. Peairs. Dept. of Ob/Gyn, University of Texas Health ScienceCenter at San Antonio OBJECTIVE: We sought to determine whether the presence of intrapartum bacterial vaginosis modifies the recognized predictors of intra amniotic infection (IAI). METHODS: Between October 1993 and April 1994, B16 laboring women had a specimen obtained from the lower one-third of the vagina evaluated for the presence of bacterial vaginosis (BV). A BV score was determined by the semi quantitative assessment of bacterial morphotypes on Gram stain, as described by Nugent et al. and validated in pregnancy by Hillier et al. A BV score ~7 was considered diagnostic of 8V. Clinical information was abstracted using standard definitions and forms during the patient's postpartum hospitalization. IAI was diagnosed with an intrapartum temperature ->37.8°Cwith 2 of 5 of: maternal or fetal tachycardia, uterine tenderness, teukocytosis, foul amniotic fluid. RESULTS: IAI occurred in 85/816 (10.5%). BV occurred in 111 (13.6%). The likelihood of IAI by BV score is depicted below: BV Score 0-3 4-6 7-10 IAI 8.4% 14.1% 10.8% When controlled for parity, labor characteristics, meconium, and genital colonization with Group B streptococcus, intrapartum BV increased the likelihood of intra amniotic infection (adjusted odds ratio 2.24 [1.0-5.0 95th CI]). CONCLUSION: The diagnosis of asymptomatic bacterial vaginosis may be helpful in predicting intra-amniotic infection among laboring women.
148 GROUP B STREPTOCOCCUS A N D I N T R A - A M N I O T I C
INFECTION, E.R. N e w t o n , J.M. Piper, W.R. Peairs. Department of Ob/Gyn, The University of Texas Health Science Center at San Antonio OBJECTIVE: We sought to determine whether the presence of rectovaginal group B streptococcus (GBS) is associated with intra-amniotic infection among laboring women. METHODS: Between October 1993 and April 1994, 816 laboring women had a rectovaginal specimen obtained f o r GBS. GBS was transported, isolated, and identified by standard microbiologic techniques. Clinical information was abstracted using standard definitions and forms during the postpartum hospitalization. Intra-amniotic infection (IAI) was diagnosed with an intrapartum temperature -~37.8°C with 2 of S of: maternal or fetal tachycardia, uterine tenderness, leukocytosis, foul amniotic fluid. Confounding variables were controlled by using stepwise logistic regression. RESULTS: IAI occurred in 85/816 (10.5%) of patients. 95 (11.7%) had positive cultures for GBS. The incidence o f IAI by degree of colonization is depicted below: GBS growth IAI
0 10.4%
1-2-111.1%
3-4+ 11.5%
When controlled for race,.economic status, gestational age, parity, labor characteristics, meconium0 and the presence o f bacterial vaginosis, intrapartum GBS did not influence the| likelihood of intra-amniotic infection. CONCLUSION: The identification of rectovaginal GBS in laboring women is not helpful in predicting IAI.
145
SPO Abstracts
CAN MATERNAL PLASMA C-REACTIVE PROTEIN REPLACE AMNIOCENTESIS FOR THE DE'I~CTION OF INTRA-AMNIOTIC INFECTION IN PATIENTS WITH PRETERM LABOR? H. Mufinzx, R. Romero, M. Galasso x, R. Gomez x, M. Mazor, F. Ghezzl x, L Coh~ x, M. Ossandon x, D.B. Cotton. Wayne State University/Hutzel Hospital, Detroit, MI, Perinatology Research Branch, NICHD, Betheada, MD. BACKGROUND/OB,IF~TIVE: Recently much emphasis has been placed on the use of araniotic fluid (AF) tests to detect intra-amniotic infection in patientswith preterm labor. However, AF analysisrequires the performance of an invasive procedure: amniocentesis. Several groups have proposed the use of maternal C-Reactive Protein (CRP) as a less invasive alternative to amniocentesis. This study was conducted to compare the diagnostic performance of maternal plasma C R P vs. A F analysis. S T U D Y DESIGN: Maternal plasma was obtained at the time of aranioccntesisin 134 consecutivepatientswith singletongestationsadmitted with the diagnosisof preterm labor and intactmembranes. Maternal plasma C R P was measured by ELISA. A F was cultured for aerobic and anaerobic bacteriaas well as Mycoplasma. T w o A F testswere performed: the Gram stain (GS) and interleukin-6(IL-6) determinations. A F IL-6 was measured by ELISA (sensitivity:1.0 ng/ml). Statisticalanalysiswas performed using R O C curve and logisticregression. R E S U L T S : I) PositiveA F cultures occurred in 13.4% of cases; 2) The sensitivityand specificityof A F analysiswas better than that of CRP; 3) Diagnostic indicesand positiveand negativepredictivevalues are displayed in the following table: Sans. Spec. PPV NFV RR 95% C.I. Anmiocnatesis 88.9% 83.6% 45.7% 98.0% 5.4 3.49-8.45 MPCRP;~20.7 /.~g/ml 64.7% 73.3% 26.2% 93.4% 4.0 1.6-10.0 Stepwise logistic analysis demonstrated that when maternal blood CRP was first entered into the model to predict AF culture results or the occurrence of preterm delivery, GS and AF IL-6 concentrations improved significantly the X2(A= 19.9). On the other hand, maternal plasma CRP did not add any significant information to that provided by AF analysis with GS and IL-6. CONCLUSION: Amniotic fluid analysis is superior to maternal plasma CRP in both the detection of infection and the prediction of tocolysis failure (i.e., preterm delivery).
146 PREDICTORS OF GENITAL COLONIZATION W I T H GROUP B
STREPTOCOCCUS(GBS) IN LABORING WOMEN E.R: Newton, J. Piper, W Peairs. Dept. of Ob/Gyn, University of Texas Health ScienceCenter at San Antonio. OBJECTIVE: We sought to determine demographic and clinical predictors of genital colonization with Group R Streptococcus (GBS)among laboring women. METHODS: Between October 1993 and April 1994, B16 laboring women had a rectovaginal culture for GBS. GBS was transported, isolated, and identified using standard microbiologic techniques. Clinical information was abstracted using standard definitions and forms during the postpartum hospitalization. Predictors were identified using stepwise logistic regression. RESULTS: 95 (11.7%) had positive genital cultures for GBS. A positive history for human papillomavirus (HPV) infection (warts or abnormal Pap smear) was associated with positive rectovaginal GBS cultures (adjusted odds ratio, 2.2 [1.09-4.45 95th CI]) and heavy colonization (3-4+), 2.7 (1.31-5.53). Preterm gestation was associated with heavy colonization, 1.9 (1.04-3.43). Race, economic status, age <20, nulliparity, other STD, meconium, smoking, nor drug abuse were associated with GBS colonization. CONCLUSION: A history of clinical HPV infection is an additional criterion to identify laboring women at risk for rectovaginal colonization with GBS. The greater risk of GBS neonatal sepsis in preterm deliveries than in term deliveries may be related in part to the greater likelihood for heavy colonization in preterm gestation. Except for preterm labor, most other common demographic and clinical markers will not identify a population to selectively screen and treat for GBScolonization.
J a n u a r y 1995 A m J Obstet Gynecol
147 DOES THE PRESENCE OF BACTERIAL VAGINOSIS INTRAPARTUM
INCREASE THE LIKELIHOODOF INTRA-AMNIOTIC INFECTION? E.R:
Newton, J. Piper, W. Peairs. Dept. of Ob/Gyn, University of Texas Health ScienceCenter at San Antonio OBJECTIVE: We sought to determine whether the presence of intrapartum bacterial vaginosis modifies the recognized predictors of intra amniotic infection (IAI). METHODS: Between October 1993 and April 1994, B16 laboring women had a specimen obtained from the lower one-third of the vagina evaluated for the presence of bacterial vaginosis (BV). A BV score was determined by the semi quantitative assessment of bacterial morphotypes on Gram stain, as described by Nugent et al. and validated in pregnancy by Hillier et al. A BV score ~7 was considered diagnostic of 8V. Clinical information was abstracted using standard definitions and forms during the patient's postpartum hospitalization. IAI was diagnosed with an intrapartum temperature ->37.8°Cwith 2 of 5 of: maternal or fetal tachycardia, uterine tenderness, teukocytosis, foul amniotic fluid. RESULTS: IAI occurred in 85/816 (10.5%). BV occurred in 111 (13.6%). The likelihood of IAI by BV score is depicted below: BV Score 0-3 4-6 7-10 IAI 8.4% 14.1% 10.8% When controlled for parity, labor characteristics, meconium, and genital colonization with Group B streptococcus, intrapartum BV increased the likelihood of intra amniotic infection (adjusted odds ratio 2.24 [1.0-5.0 95th CI]). CONCLUSION: The diagnosis of asymptomatic bacterial vaginosis may be helpful in predicting intra-amniotic infection among laboring women.
148 GROUP B STREPTOCOCCUS A N D I N T R A - A M N I O T I C
INFECTION, E.R. N e w t o n , J.M. Piper, W.R. Peairs. Department of Ob/Gyn, The University of Texas Health Science Center at San Antonio OBJECTIVE: We sought to determine whether the presence of rectovaginal group B streptococcus (GBS) is associated with intra-amniotic infection among laboring women. METHODS: Between October 1993 and April 1994, 816 laboring women had a rectovaginal specimen obtained f o r GBS. GBS was transported, isolated, and identified by standard microbiologic techniques. Clinical information was abstracted using standard definitions and forms during the postpartum hospitalization. Intra-amniotic infection (IAI) was diagnosed with an intrapartum temperature -~37.8°C with 2 of S of: maternal or fetal tachycardia, uterine tenderness, leukocytosis, foul amniotic fluid. Confounding variables were controlled by using stepwise logistic regression. RESULTS: IAI occurred in 85/816 (10.5%) of patients. 95 (11.7%) had positive cultures for GBS. The incidence o f IAI by degree of colonization is depicted below: GBS growth IAI
0 10.4%
1-2-111.1%
3-4+ 11.5%
When controlled for race,.economic status, gestational age, parity, labor characteristics, meconium0 and the presence o f bacterial vaginosis, intrapartum GBS did not influence the| likelihood of intra-amniotic infection. CONCLUSION: The identification of rectovaginal GBS in laboring women is not helpful in predicting IAI.